Atopic dermatitis is a common chronic inflammatory skin condition. The treatment aims to relieve itching, reduce redness and swelling, repair the skin barrier, and prevent recurrence. Treatment plans should be personalized based on the patient's age, severity of symptoms, and disease stage. Long-term management is key to controlling the condition.
Therapeutic strategies typically combine pharmacological and non-pharmacological methods, emphasizing patient education and daily skin care. Medical guidelines recommend a stepwise approach, adjusting treatment intensity according to disease severity while monitoring for side effects and efficacy.
Recent research indicates that combined therapies that modulate the immune system and repair the skin barrier can significantly improve patients' quality of life. The following sections detail the principles, methods, and precautions of various treatment options.
Management of eczema is divided into two main phases: the acute flare-up and the chronic maintenance phase. The acute phase focuses on rapid symptom relief, often using high-dose medications; the chronic phase emphasizes long-term control and prevention. The main treatment modalities include:
Choice of treatment should consider the patient's age. For example, infants should avoid potent steroids, while adolescents and adults may employ more flexible treatment combinations. Physicians will develop a phased treatment plan based on the affected skin area, itch severity, and risk of complications.
Topical corticosteroids are the most commonly used first-line medications, classified into seven potency levels, from mild 1% hydrocortisone to potent fluticasone propionate. Mild symptoms may be treated with low-potency agents on the face and skin folds, while severe redness and swelling require medium to high-potency agents for short-term use.
Proper application involves applying a thin layer 1-2 times daily to affected areas. During acute flare-ups, use should not exceed two weeks; during chronic management, switch to low-potency agents for maintenance. Long-term use may cause skin atrophy or folliculitis, so dosage adjustments should be made under medical supervision.
Non-steroidal drugs such as tacrolimus and pimecrolimus are used for patients who do not respond well to steroids or require long-term therapy. These drugs inhibit T lymphocyte activation and reduce inflammation. They are suitable for sensitive areas like the face and axillae but may cause initial burning or stinging sensations.
New biologic agents, such as IL-4/13 inhibitors, have been approved for moderate to severe eczema. By blocking specific inflammatory mediators, they can significantly reduce symptoms. These drugs require subcutaneous injections or intravenous infusions and are suitable for adult patients unresponsive to traditional treatments.
Oral antihistamines (such as cetirizine) can alleviate nocturnal itching, with second-generation drugs having fewer side effects. If bacterial infection with Staphylococcus aureus is present, topical or oral antibiotics should be used to prevent worsening of pustular lesions.
Narrowband UVB or PUVA therapy can suppress epidermal proliferation and inflammatory mediators, suitable for adults with large affected areas. Treatments are typically administered 2-3 times weekly in specialized clinics to avoid excessive UV exposure.
Emerging 308 nm monochromatic excimer laser therapy can target lesions specifically, reducing damage to normal skin, suitable for facial or extremity lesions.
Wet wrap therapy involves covering affected areas with medicated moist bandages, enhancing drug absorption and maintaining skin hydration. It is often used for children with severe itching or redness, with careful temperature control to prevent irritation.
Cold compresses or ice packs can provide immediate itch relief but should not contact the skin for more than 15 minutes to prevent frostbite. Applying moisturizer immediately after cold therapy enhances benefits.
Behavioral techniques include managing itching through methods like cold compresses and wearing cotton gloves to prevent skin damage. Psychological counseling can help improve anxiety or depression caused by long-term skin issues, especially in adolescents with significant cosmetic concerns.
Apply fragrance-free emollients at least twice daily, immediately after bathing for optimal absorption. Products containing ceramides and urea help restore skin barrier function.
Avoid hot water baths; water temperature should be below 38°C, and bathing should be limited to 10 minutes. Incorporating moisturizing routines into daily life reduces the risk of symptom rebound.
Maintain indoor humidity at 40-60%, using dehumidifiers or air purifiers to reduce dust mites and allergens. Bedding and clothing should be made of 100% cotton, washed weekly at temperatures above 60°C to eliminate allergens.
Some patients may find certain foods trigger symptoms; keeping a food diary can help identify potential allergens. Omega-3 fatty acids and vitamin D supplements may help modulate immune responses but should be used under medical guidance.
Stress management is crucial for preventing flares. Practices like mindfulness meditation and regular exercise can lower cortisol levels and reduce inflammation. Patients should establish a daily 15-minute relaxation routine.
Gene therapy and allergen immunotherapy are in clinical trials, targeting IL-31 receptors or JAK-STAT pathways. New oral medications may reduce the need for long-term steroid use. Minimally invasive techniques like microneedle delivery of moisturizers are under development to enhance skin barrier repair.
Artificial intelligence-assisted diagnostic systems can analyze skin images in real-time, helping physicians tailor treatment plans. Personalized medicine, combined with genetic testing, may enable more precise treatment strategies based on individual gene expression profiles such as IL-4Rα.
Seek immediate medical attention if: symptoms do not improve within 72 hours; skin develops yellow crusting or pus; fever accompanies skin redness and swelling. If scratching causes dermal damage, signs of infection, or resistance to conventional medications, refer to a dermatologist for evaluation.
For pediatric patients, if itching affects sleep or activity, causes psychological distress, or if home care measures are ineffective, schedule a specialist consultation. The doctor may recommend allergy testing, medication adjustments, or secondary phototherapy.
Patients can choose hypoallergenic, fragrance-free cosmetics, but should avoid products containing preservatives (such as MIT, CI), fragrances, or alcohol. It is recommended to perform patch testing on a small skin area first to observe for irritation or allergic reactions. Products labeled "hypoallergenic" or "suitable for sensitive skin" are generally safer.
What non-pharmacological methods can help reduce symptoms in daily life?Maintaining skin hydration is crucial. Use fragrance-free lotions or ointments daily to lock in moisture. Avoid scratching by trimming nails and wearing cotton clothing to reduce friction. Environmental control, such as using humidifiers to maintain indoor humidity at 40-60%, and regularly cleaning bedding to reduce dust mite exposure, can also help.
What measures can be taken during winter when skin dryness worsens?Winter heating can cause excessive dryness. Keep bathing water below 32°C and limit baths to 5 minutes. Immediately after bathing, apply oils or thick creams (like petroleum jelly) to lock in moisture. Using products containing urea or lactic acid can help restore the skin barrier.
Does using steroid ointments cause skin thinning or resistance? How should they be used correctly?Short-term use of moderate potency steroids as directed is generally safe. However, long-term or high-concentration use may lead to skin thinning or telangiectasia. Follow medical instructions: use stronger agents on the trunk and weaker ones on the face and folds. Once symptoms improve, gradually reduce the dosage and focus on moisturizing.
Can patients with atopic dermatitis receive vaccinations? Are there special precautions?Patients can receive vaccines normally, but should avoid injecting into affected skin areas. If on immunosuppressants (like cyclosporine), inform the doctor to evaluate vaccine efficacy. Post-vaccination redness is common; however, if accompanied by swelling, pus, or severe itching, seek medical attention promptly to assess infection risk.
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